National Health Policy 2017 | Medical Science Optional Notes for UPSC PDF Download

Introduction

The National Health Policy of 1983 and the National Health Policy of 2002 have effectively guided the approach to the health sector in the Five-Year Plans. However, the current landscape has undergone significant transformations in four key aspects.

• Firstly, there is a shift in health priorities. Despite substantial declines in maternal and child mortality, there is an increasing burden associated with non-communicable diseases and certain infectious diseases.
• Secondly, a notable change is the emergence of a robust healthcare industry, projected to grow at a double-digit rate.
• Thirdly, there is a rising incidence of catastrophic expenditure resulting from healthcare costs, which is currently identified as a major contributor to poverty.
• Fourthly, the escalating economic growth has led to enhanced fiscal capacity. Consequently, there is a need for a new health policy that is responsive to these contextual changes.

The 2017 National Health Policy (NHP, 2017) strives for a comprehensive and integrated approach to encompass everyone, promoting wellness. Its primary objectives include attaining universal health coverage and providing high-quality healthcare services to all at an affordable cost.

Goal

The policy's overarching aim is to achieve the highest attainable level of health and well-being for everyone across all age groups. This involves adopting a preventive and promotive healthcare approach embedded in all developmental policies, ensuring universal access to high-quality healthcare services without imposing financial burdens. This overarching goal will be realized by enhancing access, elevating quality, and reducing the overall cost of healthcare delivery.

Objectives

The policy seeks to enhance health status by implementing concerted policy measures across all sectors. It aims to broaden the scope of preventive, promotive, curative, palliative, and rehabilitative services within the public health sector, with a strong emphasis on improving quality.

Health Status and Programme Impact

Life Expectancy and Health:

• Increase the Life Expectancy at birth from 67.5 to 70 by 2025.
• Implement regular tracking of the Disability Adjusted Life Years (DALY) Index by 2022, serving as a measure of the disease burden and its trends across major categories.
• Achieve a national and sub-national reduction of Total Fertility Rate (TFR) to 2.1 by 2025.

Mortality by Age and/or Cause:

• Decrease Under Five Mortality to 23 by 2025 and Maternal Mortality Ratio (MMR) to 100 by 2020.
• Reduce infant mortality rate to 28 by 2019.
• Lower neo-natal mortality to 16 and achieve a "single-digit" stillbirth rate by 2025.

Reduction of Disease Prevalence/Incidence:

• Attain the global target of 90:90:90 for HIV/AIDS by 2020, ensuring that 90% of all individuals living with HIV are aware of their status, 90% of diagnosed individuals receive sustained antiretroviral therapy, and 90% of those on therapy achieve viral suppression.
• Attain and sustain elimination status for Leprosy by 2018, Kala-Azar by 2017, and Lymphatic Filariasis in endemic pockets by 2017.
• Achieve and maintain a cure rate exceeding 85% in new sputum-positive tuberculosis patients and work towards eliminating new cases by 2025.
• Decrease the prevalence of blindness to 0.25 per 1000 and reduce the disease burden by one-third by 2025.
• Reduce premature mortality from cardiovascular diseases, cancer, diabetes, or chronic respiratory diseases by 25% by 2025.

Health Systems Performance

Coverage of Health Services:

• Increase the utilization of public health facilities by 50% from existing levels by 2025.
• Maintain antenatal care coverage and skilled attendance at birth above 90% each by 2025.
• Ensure that over 90% of newborns are fully immunized by the age of one by 2025.
• Meet the family planning needs of over 90% at both national and sub-national levels by 2025.
• Ensure that 80% of known hypertensive and diabetic individuals at the household level maintain a "controlled disease status" by 2025.

Cross-Sectoral Goals Related to Health:

• Achieve a relative reduction of 15% in the prevalence of current tobacco use by 2020 and 30% by 2025.
• Reduce the prevalence of stunting in children under five by 40% by 2025.
• Ensure access to safe water and sanitation for all by 2020 (Swachh Bharat Mission).
• Halve the incidence of occupational injuries from the current level of 334 per lakh agricultural workers by 2020.
• Implement national/state-level tracking of selected health behaviors.

Health Systems Strengthening

Health Finance:

• Enhance government health expenditure as a percentage of GDP from the current 1.15% to 2.5% by 2025.
• Increase state sector health spending to over 8% of their budget by 2020.
• Reduce the proportion of households experiencing catastrophic health expenditure by 25% from current levels by 2025.

Health Infrastructure and Human Resources:

• Ensure the availability of paramedics and doctors in accordance with Indian Public Health Standard (IPHS) norms in high-priority districts by 2020.
• Increase the ratio of community health volunteers to the population as per IPHS norms in high-priority districts by 2025.
• Establish primary and secondary care facilities in high-priority districts, adhering to norms in terms of both population and time-to-reach, by 2025.

Health Management Information:

• Establish a district-level electronic database containing information on health system components by 2020.
• Strengthen the health surveillance system and create registries for diseases of public health importance by 2020.
• Establish a federated integrated health information architecture, Health Information Exchanges, and the National Health Information Network by 2025.

Policy Thrust

Ensuring Sufficient Investment:

• The policy sets forth an attainable target of increasing public health expenditure to 2.5% of the GDP within a defined timeframe.

Preventive and Promotive Health:

• The policy outlines coordinated action on seven priority areas to enhance the health environment:

Swachh Bharat Abhiyan

• Promotion of balanced, healthy diets, and regular exercise
• Addressing issues related to tobacco, alcohol, and substance abuse
• Yatri Suraksha: Preventing deaths due to rail and road traffic accidents
• Nirbhaya Nari: Taking action against gender violence
• Stress reduction and improved safety in the workplace
• Mitigating indoor and outdoor air pollution

Organization of Public Health Care Delivery:

• The policy suggests seven key policy shifts in the organization of healthcare services.

Rashtriya Swasth Bhima Yojana (RSBY)

• RSBY stands as a government-sponsored initiative designed for the Below Poverty Line (BPL) population in India.
• The primary source of funding, constituting approximately 75%, is supplied by the Government of India (GOI), with the remaining portion covered by the respective state governments.
• In the case of North-eastern states and Jammu and Kashmir, the Government of India contributes 90%, requiring the respective state governments to contribute only 10% of the premium.
• Beneficiaries are required to pay a nominal registration fee of Rs. 30, earmarked for covering administrative expenses under the scheme.
• Also recognized as the National Health Insurance Scheme (NHIS).
• The Rashtriya Swasthya Bima Yojana (RSBY) was officially initiated on April 1, 2008.

Objective:

To shield Below Poverty Line (BPL) households from financial responsibilities stemming from health-related emergencies requiring hospitalization.

Beneficiaries:

RSBY beneficiaries have access to hospitalization coverage, with a limit of Rs. 30,000 per family per year for hospitalization in both public and private hospitals. In the unfortunate event of the death of a family member, a coverage amount of Rs. 25,000 is provided. Pre-existing conditions are covered from the outset, and there is no age limit. The coverage encompasses up to five family members, comprising the head of the household, spouse, and up to three dependents.

Ayushman Bharat

Launched in 2018 as part of the Ayushman Bharat Mission by the Ministry of Health and Family Welfare (MoHFW) in India, Ayushman Bharat Yojana, also known as Pradhan Mantri Jan Arogya Yojana (PMJAY) or the National Health Protection Scheme, is a centrally sponsored initiative.

The Health and Wellness Centres, envisioned as the cornerstone of India's health system by the National Health Policy of 2017, are the focal point that the scheme aims to establish.

Launched as per the recommendations of the National Health Policy 2017, Ayushman Bharat is a flagship scheme of the Government of India aimed at realizing the vision of Universal Health Coverage (UHC). This initiative aligns with Sustainable Development Goals (SDG) and its core commitment of "leave no one behind."

Ayushman Bharat-Two major initiatives

Ayushman Bharat-Health and wellness centers

In February 2018, the Government of India unveiled plans to establish 1,50,000 Health and Wellness Centres (HWCs) by transforming existing Sub Centres and Primary Health Centres. These centers are designed to provide Comprehensive Primary Health Care (CPHC), bringing healthcare closer to people's homes, encompassing maternal and child health services, as well as addressing non-communicable diseases. The Health and Wellness Centers are envisioned to offer an expanded array of services, addressing the primary health care needs of the entire local population, thereby enhancing access, universality, and equity within the community. The emphasis on health promotion and prevention aims to concentrate on maintaining overall well-being by involving and empowering individuals and communities, encouraging healthy behaviors, and instigating changes that mitigate the risk of developing chronic diseases and morbidities.

Ayushman Bharat-PM JAY

PM-JAY seeks to offer health insurance coverage of Rs. 5 lakhs annually for secondary and tertiary care hospitalization to more than 10.74 crore economically disadvantaged and vulnerable families, amounting to approximately 50 crore beneficiaries. The scheme does not impose any limit on the family size.

PM-JAY is entirely financed by the government, with the implementation costs shared between the Central and State Governments.

Ayushman Bharat-PM JAY Key features

• It stands as the world's largest government-funded health insurance/assurance scheme.
• PM-JAY offers coverage of Rs. 5 lakhs per family annually for secondary and tertiary care hospitalization, accessible in both public and private empaneled hospitals across India.
• Over 10.74 crore economically disadvantaged and vulnerable families, constituting around 50 crore beneficiaries, are eligible for these benefits.
• PM-JAY ensures cashless access to healthcare services for beneficiaries directly at the hospital.
• The scheme aims to reduce catastrophic expenditure leading to the impoverishment of 6 crore individuals annually and to alleviate the financial risks associated with severe health incidents.
• There are no restrictions based on family size, age, or gender.
• All pre-existing conditions receive coverage from the first day.
• The coverage extends to 3 days of pre-hospitalization and 15 days of post-hospitalization expenses, encompassing diagnostics and medicines.
• Scheme benefits are portable nationwide, allowing beneficiaries to access cashless treatment at any empaneled public or private hospital.
• The services include around 1,393 procedures, covering all associated treatment costs, such as drugs, supplies, diagnostic services, physician's fees, room charges, surgeon charges, OT and ICU charges, etc.
• Public hospitals receive reimbursement for healthcare services equivalent to that of private hospitals.

PM-JAY (Beneficiaries)

Rural Beneficiaries:
Among the seven deprivation criteria designated for rural areas, PM-JAY encompasses all families falling under at least one of the following six deprivation criteria (D1 to D5 and D7) along with automatic inclusion criteria (Destitute/living on alms, manual scavenger households, primitive tribal group, legally released bonded labour):

• D1 - Single-room dwellings with kucha walls and kucha roof
• D2 - Absence of an adult member aged between 16 to 59
• D3 - Households lacking an adult male member between ages 16 to 59
• D4 - Presence of a disabled member with no able-bodied adult member
• D5 - SC/ST households
• D7 - Landless households deriving a significant portion of their income from manual casual labor

Urban Beneficiaries:
For urban areas, individuals falling within the following 11 occupational categories are eligible for the scheme:

• Ragpicker
• Beggar
• Domestic worker
• Street vendor/Cobbler/Hawker/Other service provider working on streets
• Construction worker/Plumber/Mason/Labour/Painter/Welder/Security guard/Coolie and other head-load workers
• Sweeper/Sanitation worker/Mali
• Home-based worker/Artisan/Handicrafts worker/Tailor
• Transport worker/Driver/Conductor/Helper to drivers and conductors/Cart puller/Rickshaw puller
• Shop worker/Assistant/Peon in small establishments/Helper/Delivery assistant/Attendant/Waiter
• Electrician/Mechanic/Assembler/Repair worker
• Washer-man/Chowkidar

PM-JAY (Excluded)

As per the SECC (SocioEconomic Caste Census 2011), the following beneficiaries are automatically excluded:

• Households possessing motorized 2/3/4 wheelers or fishing boats
• Households equipped with mechanized 3/4 wheeler agricultural machinery
• Households holding a Kisan Credit Card with a credit limit exceeding Rs. 50,000/-
• A household member employed in a government position
• Households with non-agricultural enterprises duly registered with the government
• Any household member earning a monthly income exceeding Rs. 10,000/-
• Households subject to income tax payment
• Households liable for professional tax
• Residences featuring three or more rooms with solid walls and roofs
• Ownership of a refrigerator
• Possession of a landline phone
• Ownership of more than 2.5 acres of irrigated land with corresponding irrigation equipment
• Ownership of 5 acres or more of irrigated land for two or more crop seasons
• Ownership of at least 7.5 acres of land or more, inclusive of at least one irrigation equipment.

Ayushman Bharat-Status

National Digital Health Mission

Idea 

Through the Digital Health Infrastructure established by NDHM, rather than transporting medical records in plastic bags from one doctor to another, individuals in India will have the capability to retrieve their lab reports, x-rays, and prescriptions, regardless of their origin. They can then share these records with doctors or family members, with consent, facilitating seamless accessibility and information exchange.

Key Features:

• Six fundamental building blocks or digital systems, namely HealthID, DigiDoctor, Health Facility Registry, Personal Health Records, e-Pharmacy, and Telemedicine.
• Unique Health ID: Each Indian covered by the mission will receive an ID card containing comprehensive information about their medical conditions, treatments, tests, etc.
• Comprehensive Health Profile: From doctor appointments to prescribed medications and medical tests, every detail will be available in the health profile of an individual across public and private healthcare.
• The National Health Authority (NHA), an attached office of the Ministry of Health & Family Welfare, has the mandate to design, build, roll out, and implement the NDHM in the country.
• Encouraging Private Players: Private stakeholders have an equal opportunity to integrate with these building blocks and develop their products for the market. However, core activities like generating Health ID or approving a doctor/facility will remain with the government.
• Additional Components: Private players can develop Personal Health Record (PHR) and Electronic Medical Record (EMR) solutions in line with the issued guidelines.

Merits:

• Establishes Digital Health
• Voluntary Scheme
• Data Safeguards
• Improves Healthcare Service Efficiency
• Addresses Healthcare Challenges
• Reduces Information Asymmetry
• Aligned with International Goals
• Resolves Last Mile Connectivity Issues
• Addresses Data Ownership Issues